28 year female presented to us with X-ray chest suggestive of right opaque hemithorax. She was on anti-tubercular treatment for the presence of Acid Fast Bacilli (AFB) in pleural fluid. Clinical examination revealed bronchial breathing on right side. CT thorax showed large mass lesion in right hemi thorax with mild pleural effusion. Thoracocentesis and bronchoscopy showed no evidence of malignancy however AFB were detected in bronchial washing. Transthoracic biopsy was positive for malignancy. On Immunohistochemistry (IHC), Thyroid Transcription Factor 1(TTF1) and NAPSIN A were positive, confirming the diagnosis of adenocarcinoma lung. Final diagnosis of primary adenocarcinoma lung with concomitant tuberculosis was established.
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